GASTROINTESTINAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 267

Hemorrhoids (piles) are abnormally dilated veins that protrude from the anus. They are
usuallypresentbeforeajourneybeginsbutcanbeaggravatedbytheconstipationthatcom-
monly develops with new foods, prolonged sitting, and irregular schedules. (Individuals
with preexisting hemorrhoids should have them assessed by a colorectal surgeon before a
major wilderness outing.) Hemorrhoids usually are more annoying than disabling but can
be a source of considerable itching and discomfort and can cause severe pain if they be-
come prolapsed and thrombosed. Hemorrhoids bleed modestly following a hard or bulky,
densebowelmovement,butseriousbleedingisrare.Thebloodisusuallynotedonthetoilet
paper or on the outside of the stool; blood mixed within the stool could suggest bleeding
from the colon, a much more serious problem.
If hemorrhoids become bothersome in the field, measures to soften and lubricate the
stool—mostimportant,agenerouswaterintake—andonetablespoonofmineraloiltwicea
day may provide relief. Bearing down during bowel movements should be avoided. Sitting
in warm water for ten to fifteen minutes several times a day helps relieve symptoms but
interfereswithoutdooractivities. BulkformerssuchasMetamucil® maybehelpfulduring
an acute episode. Hemorrhoidal suppositories or creams may relieve symptoms.
Thrombosed Hemorrhoid
The blood within a hemorrhoid occasionally clots, resulting in significant anal pain that
may come on gradually or suddenly. A purple nodule that is firm and tender can be seen
protrudingfromtheanalopeningorcanbefeltjustinside.Clots smaller thanone-halfinch
(1.25 cm) in diameter are best allowed to resolve spontaneously. Clots larger than one inch
(2.5 cm) may require surgical therapy to evacuate the clot. The severity of the pain should
determine how clots between these two sizes should be treated.
An incision in the top of the thrombosed hemorrhoid and evacuation of the clot can
provide dramatic relief of pain. Days of distress can be avoided if the thrombosed hemor-
rhoidislarge.Beforeincision,theanusshouldbewashedwithsoapandwater.Amoderate
analgesic can be given prior to incision. Ice or snow pressed against the nodule provides
surprisingly effective anesthesia. The incision should be left open, and pads should be left
in the intergluteal cleft to reduce soiling by blood. Warm baths help relieve pain and anal
muscle spasm.
Rectal Abscess
Abscesses in the tissues surrounding the rectum and anus usually follow long-standing
anal problems such as fissures or hemorrhoids, which should be corrected before a pro-
longed wilderness outing. Abscesses in this location are not basically different from abs-
cesses elsewhere in the body.
The cardinal symptom of a rectal abscess is throbbing pain in the region of the anus.
Malaise, fever, and chills are common, and the individual may appear acutely ill. Examin-